Provider Demographics
NPI:1386013852
Name:CLARK, ANDREW PHILLIP (LAC LMT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:PHILLIP
Last Name:CLARK
Suffix:
Gender:M
Credentials:LAC LMT
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 SNOWS CT
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3307
Mailing Address - Country:US
Mailing Address - Phone:917-771-7163
Mailing Address - Fax:
Practice Address - Street 1:251 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4188
Practice Address - Country:US
Practice Address - Phone:917-771-7163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005636-1171100000X
NH279171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist